Systematic review and meta-analysis on prevalence, pattern, and factors associated with ocular protection practices among welders in sub-Saharan Africa.

Background: Due to hazardous working conditions, welders are more likely to be exposed to mild to severe eye issues during the welding process. Globally, this issue is a major contributor to vision loss and blindness. One of the most frequent causes of unilateral blindness in the globe is ocular injury. Objective: This review aimed to assess the pooled prevalence of ocular protection practice and associated factors among welders in sub-Saharan Africa. Methods: Databases including PubMed, Scopus, web of Science, Google Scholar, and the African Journals Online were systematically searched for relevant literature. The statistical analysis was performed using STATA data analysis software version 14, while Microsoft Excel was used for data abstraction. We checked publication bias using a funnel plot and Egger and Begg regression tests. A p-value < 0.05 was considered significant, suggesting the presence of presence publication bias. The I2 statistics were used to assess heterogeneity between studies. The study's overall effect was evaluated using the random effects model. Results: From retrieved 2,326 original studies, 17 studies were included in the final pooled prevalence analysis. The overall prevalence of ocular protection practice among small-scale welders in sub-Saharan Africa was 53.71% (95% CI: 42.54, 64.88). Having pre and in-service training [AOR: 4.97, 95% CI: (2.64, 9.36)], having work experience as a welder [AOR: 4.94, 95% CI: (3.24, 7.54)], and having a history of ocular injury [AOR: 2.99, 95% CI: (1.58, 5.66)] were significantly associated with the ocular protection practices. Conclusions: In sub-Saharan African countries, the ocular protection practices among small-scale welders were low. Furthermore, the current meta-analysis found ocular protection practice to be significantly associated with on-the-job training, work experience of welders, and a history of ocular injury in the past year of small-scale welders in sub-Saharan Africa. This review will serve as baseline data for further studies to generate inputs for eye care providers and policymakers to improve good practice levels about ocular protection. Policies should be put in place to ensure all welders use proper personal-protective equipment, and receive regular health training.

Mapping geographical inequalities of incomplete immunization in Ethiopia: a spatial with multilevel analysis.

Background: Immunization is one of the most cost-effective interventions, averting 3.5-5 million deaths every year worldwide. However, incomplete immunization remains a major public health concern, particularly in Ethiopia. The objective of this study is to investigate the geographical inequalities and determinants of incomplete immunization in Ethiopia. Methods: A secondary analysis of the mini-Ethiopian Demographic Health Survey (EDHS 2019) was performed, utilizing a weighted sample of 3,865 children aged 12-23 months. A spatial auto-correlation (Global Moran's I) statistic was computed using ArcGIS version 10.7.1 to assess the geographical distribution of incomplete immunization. Hot-spot (areas with a high proportion of incomplete immunization), and cold spot areas were identified through Getis-Ord Gi* hot spot analysis. Additionally, a Bernoulli probability-based spatial scan statistics was conducted in SaTScan version 9.6 software to determine purely statistically significant clusters of incomplete immunization. Finally, a multilevel fixed-effects logistic regression model was employed to identify factors determining the status of incomplete immunization. Results: Overall, in Ethiopia, more than half (54%, 95% CI: 48-58%) of children aged 12-23 months were not fully immunized. The spatial analysis revealed that the distribution of incomplete immunization was highly clustered in certain areas of Ethiopia (Z-score value = 8.379419, p-value < 0.001). Hotspot areas of incomplete immunization were observed in the Afar, Somali, and southwestern parts of Ethiopia. The SaTScan spatial analysis detected a total of 55 statistically significant clusters of incomplete immunization, with the primary SaTScan cluster found in the Afar region (zones 1, 3, and 4), and the most likely secondary clusters detected in Jarar, Doola, Korahe, Shabelle, Nogob, and Afdar administrative zones of the Somali region of Ethiopia. Indeed, in the multilevel mixed-effect logistic regression analysis, the respondent's age (AOR: 0.92; 95% CI: 0.86-0.98), residence (AOR: 3.11, 95% CI: 1.36-7.14), living in a pastoralist region (AOR: 3.41; 95% CI: 1.29-9.00), educational status (AOR: 0.26; 95% CI: 0.08-0.88), place of delivery (AOR: 2.44; 95% CI: 1.15-5.16), and having PNC utilization status (AOR: 2.70; 95% CI: 1.4-5.29) were identified as significant predictors of incomplete immunization. Conclusion and recommendation: In Ethiopia, incomplete immunization is not randomly distributed. Various factors at both individual and community levels significantly influence childhood immunization status in the country. It is crucial to reduce disparities in socio-demographic status through enhanced collaboration across multiple sectors and by bolstering the utilization of maternal health care services. This requires concerted efforts from stakeholders.

Knowledge and factors associated with active management of the third stage of labor in sub-Saharan Africa: A systematic review and meta-analysis.

BACKGROUND: Postpartum hemorrhage (PPH) is one of the leading causes of maternal mortality in sub-Saharan Africa. Implementing active management in the third stage of labor has significantly reduced the incidence of PPH. Thus, understanding the level of healthcare providers' knowledge of active management in the third stage of labor can inform guidelines, policies, and practices for effectively preventing PPH. OBJECTIVE: This review aimed to assess the level of healthcare providers' knowledge and associated factors of active management in the third stage of labor in sub-Saharan Africa. SEARCH STRATEGY: We conducted a search using PubMed, Scopus, Web of Science, Google Scholar, Cochrane Library, and the African Journals online international databases. SELECTION CRITERIA: The inclusion criteria were determined before the review of the articles and adhere to the criteria of population, intervention, comparison, and outcome. DATA COLLECTION AND ANALYSIS: Statistical analysis was performed using STATA data analysis software version 14, while Microsoft Excel was utilized for data abstraction. We checked publication bias using a funnel plot and Egger and Begg regression tests. A P value less than 0.05 was considered statistically significant, suggesting the presence of presence publication bias. The I2 statistic was used to assess heterogeneity between studies. The study's overall effect was evaluated using the random effects model. MAIN RESULT: The study included 20 studies to conduct a pooled prevalence analysis. The overall prevalence of healthcare providers' knowledge of active management of third-stage labor in sub-Saharan Africa was 47.975% (95% CI: 32.585, 63.365). Having pre- and in-service training (AOR: 2.25, 95% CI: 1.00, 5.08), having a higher degree (AOR: 1.98, 95% CI: 1.39, 2.82), and having good practices (AOR: 8.91, 95% CI: 4.58, 17.40) were significantly associated with healthcare provider's knowledge regarding active management third stage of labor. CONCLUSIONS: The overall healthcare providers' knowledge of active management of the third stage of labor (AMTSL) was low in sub-Saharan Africa. Obstetric healthcare providers should undertake comprehensive training covering all AMTSL components through pre- and in-service diploma training programs.

Hotspot areas of risky sexual behaviour and associated factors in Ethiopia: Further spatial and mixed effect analysis of Ethiopian demographic health survey.

INTRODUCTION: Sexual behaviour needs to take a central position in the heart of public health policy makers and researchers. This is important in view of its association with Sexually Transmitted Infections (STIs), including HIV. Though the prevalence of HIV/AIDS is declining in Ethiopia, the country is still one of the hardest hit in the continent of Africa. Hence, this study was aimed at identifying hot spot areas and associated factors of risky sexual behavior (RSB). This would be vital for more targeted interventions which can produce a sexually healthy community in Ethiopia. METHODS: In this study, a cross-sectional survey study design was employed. A further analysis of the 2016 Ethiopia Demographic and Health Survey data was done on a total weighted sample of 10,518 women and men age 15-49 years. ArcGIS version 10.7 and Kuldorff's SaTScan version 9.6 software were used for spatial analysis. Global Moran's I statistic was employed to test the spatial autocorrelation, and Getis-Ord Gi* as well as Bernoulli-based purely spatial scan statistics were used to detect significant spatial clusters of RSB. Mixed effect multivariable logistic regression model was fitted to identify predictors and variables with a p-value ≤0.05 were considered as statistically significant. RESULT: The study subjects who had RSB were found to account about 10.2% (95% CI: 9.64%, 10.81%) of the population, and spatial clustering of RSB was observed (Moran's I = 0.82, p-value = 0.001). Significant hot spot areas of RSB were observed in Gambela, Addis Ababa and Dire Dawa. The primary and secondary SaTScan clusters were detected in Addis Ababa (RR = 3.26, LLR = 111.59, P<0.01), and almost the entire Gambela (RR = 2.95, LLR = 56.45, P<0.01) respectively. Age, literacy level, smoking status, ever heard of HIV/AIDS, residence and region were found to be significant predictors of RSB. CONCLUSION: In this study, spatial clustering of risky sexual behaviour was observed in Ethiopia, and hot spot clusters were detected in Addis Ababa, Dire Dawa and Gambela regions. Therefore, interventions which can mitigate RSB should be designed and implemented in the identified hot spot areas of Ethiopia. Interventions targeting the identified factors could be helpful in controlling the problem.

Estimate the burden of malnutrition among children with cerebral palsy in Sub-Saharan Africa: a systematic review with meta-analysis.

Malnutrition is more prevalent among children with cerebral palsy and a major factor for child morbidity and mortality in children with different co-morbidity, especially in Sub-Saharan Africa: The main aim of this systematic review and meta-analysis was to estimate the burden of malnutrition among children with cerebral palsy in Sub-Saharan Africa. We searched PubMed, Web of Science, Google Scholar, Research Gate, and institutional repositories for papers that reported the proportion of malnutrition among children with cerebral palsy that were published between December 2010 and September 2023. Data were retrieved using the standardized JBI data extraction checklist through Microsoft Excel, and then exported to STATA 17 for further analysis. DerSimonian and Laird's estimator was used to calculate the pooled effect size in the random-effects model. Statistics such as the Cochran Q test and I2 test were employed to measure heterogeneity. Egger's test and the funnel plot were used to look for publication bias. This systematic review and meta-analysis used 16 studies from Sub-Saharan Africa to estimate the proportion of malnutrition among 2,120 children with cerebral palsy. The pooled proportion of malnutrition among children with cerebral palsy in Sub-Saharan Africa by using random-effects model analysis was found to be 59.7% (95% CI; 49.8-69.6). The proportion of malnutrition was also estimated by sample sizes categorized as ≤ 120 and > 120, and the proportion of malnutrition was found to be 54.0 (95% CI: 44.7-63.3) and 64.5 (95% CI: 50.5-78.5). Moreover, the proportion of malnutrition was estimated by accounting for the difference in the year of publication. In this regard, the study classified before ≤ 2017 and > 2017, and the proportion of malnutrition was found to be 53.7 (95% CI: 38.0-69.3) and 62.5 (95% CI: 49.7-75.3) in Sub-Saharan Africa respectively. Malnutrition among children with cerebral in Sub-Saharan Africa was found to be very high. Hence, enhancing and developing strategic guidelines for malnutrition screening, prevention, and nutritional support are crucial among children with cerebral palsy. Furthermore, systematic review, randomized control trials, and qualitative studies are recommended to understand the burden more among children with cerebral palsy in the continent.

Trends of Body Mass Index changes among adults on antiretroviral therapy in Northwest Ethiopia: a longitudinal data analysis.

Nutritional status is considered a major diagnostic and prognostic indicator of HIV/AIDS in adults. In this aspect, current HIV-treatment guidelines, particularly in low-income countries, recommend the regular monitoring of body mass index (BMI) to determine patients' clinical response to antiretroviral therapy (ART). However, data regarding the change in BMI status of HIV-positive adults on ART following the implementation of the test and treat strategy were limited in Ethiopia. Hence, this study is aimed at investigating the trends of BMI change over time and its associated factors among HIV-positive adults in Northwest Ethiopia. A retrospective longitudinal study was conducted among 404 randomly selected HIV-positive adults receiving ART in Felegehiwot Comprehensive Specialized Hospital (FHCSH), Northern Ethiopia. Data were extracted from the medical record charts of study participants, entered into Epi-data 4.6 software, and exported to Stata 14.2 software for analysis. A generalized estimating equation (GEE) model was fitted to determine the change in BMI status over time and its predictors in HIV-positive adults. The level of significance was declared at a p-value of < 0.05. More than half (201, or 51.73%) of the total 404 participants were female. In the cohort, both the baseline and follow-up mean body mass index levels of the participants fell in the normal range and increased from 20.34 (standard deviation/SD ± 2.8) to 21.41 (SD ± 3.13). The individual profile plots of 50 participants indicated that there is considerable variability in weight change across individuals. Duration of ART follow-up (ß = 0.203, 95% confidence interval (CI) 0.16 to 0.24), unemployment (ß = - 0.96, 95% CI 1.67 to - 0.25), WHO stage III/IV HIV disease (ß = - 0.92, 95% CI - 1.57 to - 0.35),and Tenofovir/Lamivudine/Dolutegravir (TDF/3TC/DTG)ART regimen (ß = 0.95, 95% CI 0.32 to 1.57) were identified as significant predictors of change in the BMI status of participants. Likewise, the interaction of TDF/3TC/DTG ART regimen * follow-up duration (ß = 2.16, 95% CI 1.84 to 2.84), WHO stage III/IV clinical disease * follow-up duration (ß = - 1.43, 95% CI - 1.71 to - 1.15) and TB/HIV co-infection * follow-up duration (ß = 1.89, 95% CI 1.57 to 2.87) significantly affects the trend in BMI change status of HIV-positive adults. In this study, the BMI status of HIV-positive adults receiving ART increased with a linear trend. Unemployment, stage III/IV HIV diseases, and Tenofovir/Lamivudine/Efavirenz (TDF/3TC/EFV) ART-drug regimen decreases the mean BMI status of HIV-positive adults. Special consideration and strict follow-up need to be given to those individuals with advanced HIV/AIDS diseases and other identified risk group.

Diagnostic performance of plasma D-dimer, fibrinogen, and D-dimer to fibrinogen ratio as potential biomarkers to predict hypertension-associated acute ischemic stroke.

Background: Ischemic stroke is a common type of stroke that leads to death and functional disability in hypertensive patients. However, there are no well-studied non-invasive and less expensive fluid biomarkers routinely used to detect ischemic stroke in hypertensive patients. Hence, this study aimed to tease out the performance of D-dimer, fibrinogen, and the D-dimer to fibrinogen ratio (DDFR) in predicting hypertension-associated acute ischemic stroke. Methods: A hospital-based cross-sectional study was done from October 2022 to January 2022 at Yikatit 12 Hospital Medical College, Ethiopia. We recruited 55 hypertensive patients who had an ischemic stroke and 110 who did not. A ROC curve was used to calculate the areas under the curves (AUCs) and determine the diagnostic power of the D-dimer, fibrinogen, and DDFR. The Youden index was used to find the best cut-off points for biomarkers in detecting acute ischemic stroke. A De Long test was employed to show whether there was a significant difference between the AUCs of biomarkers in diagnosing ischemic stroke. Results: D-dimer yielded the highest diagnostic power (AUC = 0.776) in detecting acute ischemic stroke, followed by DDFR (AUC = 0.763) and fibrinogen (AUC = 0.694), but there was no significant difference between them. At 0.52 µg/ml cut-off point, D-dimer had 82.9% sensitivity, 66.7% specificity, 62.5% PPV, and 85.3% NPV to diagnose acute ischemic stroke. Fibrinogen could detect acute ischemic stroke at 405.85 mg/dl level, with 70.0% sensitivity, 57.1% specificity, 41.2% PPV and 81.6% NPV. At a 1.83 ratio, DDFR might also identify ischemic stroke with 80.0% sensitivity, 67.1% specificity, 51.1% PPV, and 88.7% NPV. Conclusion: We showed D-dimer, fibrinogen, and DDFR as promising, affordable, and non-invasive biomarkers for the detection of ischemic stroke among subjects with hypertension. This will help clinicians make an early diagnosis and better guide patient therapy.

Prevalence, incidence, and trends of epilepsy among children and adolescents in Africa: a systematic review and meta-analysis.

BACKGROUND: Epilepsy contributes to a significant disease burden in children and adolescents worldwide. The incidence of childhood epilepsy is threefold higher in low and middle income countries compared in high-income countries. Epilepsy is a serious neurological condition associated with stigma and discrimination, an impaired quality of life, and other mental health related problems. OBJECTIVE: This study is aimed to synthesize existing evidence and estimate the pooled prevalence and incidence of epilepsy in children and adolescents in Africa. METHODS: A comprehensive and systematic search of relevant databases was conducted. The quality of each study was assessed using the Newcastle-Ottawa Quality Assessment Scale adapted for meta-analysis. Two reviewers screened retrieved articles, conducted critical appraisals, and extracted the data. Heterogeneity between studies was assessed by visual inspection of forest plots and statistically using Cochran's Q statistics and the I2 test. Publication bias was checked by visual inspection of funnel plots as well as statistically using Egger's correlation and Begg's regression tests. Finally, the pooled prevalence and incidence of childhood epilepsy were computed with 95% confidence intervals. RESULT: In this review and meta-analysis 42 studies with 56 findings were included to compute the pooled prevalence of childhood epilepsy. On the other hand, 6 studies were included to estimate the combined incidence. The pooled prevalence of cumulative epilepsy was 17.3 per 1000 children. Whereas the pooled prevalence of active and lifetime epilepsy was 6.8 and 18.6 per 1000 children respectively. The pooled incidence of childhood epilepsy was 2.5 per 1000 children. CONCLUSION: Nearly 1 in 50 children are suffering from epilepsy in Africa. However, little attention has been paid to the prevention and treatment of childhood epilepsy. Mass epilepsy screening, scaling up treatment coverage, and designing strict treatment follow up and monitoring mechanisms are recommended.

Dental caries and mean values of DMFT among children with cerebral palsy: a systematic review and meta-analysis.

INTRODUCTION: One of the most prevalent causes of physical disability in children is cerebral palsy (CP), which is a series of complicated neurological disorders. Children with cerebral palsy suffer from multiple problems and potential disabilities, including dental caries. Hence, this study aimed to determine the pooled prevalence of dental caries and mean DMFT (Decayed, Missed, and Filled Permanent Teeth) among children with cerebral palsy in Africa and Asia. METHODS: A comprehensive search of the literature was made to locate relevant studies in PubMed/Medline, HINARI, Web of Science, Science Direct, the Cochrane Library, the Worldwide Science Database, and Google Scholar. The data were extracted in Microsoft Excel and transferred to Stata version 17 software for further analysis. A random-effect model was employed to estimate the pooled prevalence of dental caries and the pooled mean value of DMFT among children with cerebral palsy in Africa and Asia. Heterogeneity between studies was checked using the Cochrane Q test and I2 test statistics. Sub-group analysis by continent was done, and sensitivity analysis was checked. A small study effect was checked using Egger's statistical test at the 5% level of significance. RESULTS: In this study, 25 original studies conducted in 17 countries in Africa and Asia that fulfilled the eligibility criteria were included in the review. The overall pooled prevalence of dental caries in Africa and Asia among children with cerebral palsy was 55.6% (95% CI: 42.4, 68.8). The pooled prevalence of dental caries among children with cerebral palsy in Africa was 42.43% (95% CI: 30.39, 54.58), and it was slightly higher in Asia with 64% (95% CI: 48.32, 79.72). In the random effect model analysis, the pooled mean DMFT of dental caries in children with cerebral palsy was 2.25 (95% CI: 1.86, 2.64). The pooled mean DMFT in Africa was 1.47 (95% CI: 0.86, 2.09), and in Asia it was 3.01 (95% CI: 2.43, 3.60). CONCLUSION: In this study, we found that children with cerebral palsy experienced an alarming rate of dental caries. In these settings, dental caries affected roughly more than half of the children with cerebral palsy. Hence, oral health promotion initiatives should target children with CP, and this group of children must receive early preventive dental care.

Determinants of poor glycemic control among type 2 diabetes in Ethiopia: a systematic review and meta-analysis.

Introduction: Prior primary studies have examined the prevalence and factors associated with glycaemic control among patients with type 2 diabetes mellitus, but studies with evidence-based synthesis of the primary data remained unknown. Hence, we aimed to determine the prevalence of poor glycemic control and identify determinants of poor glycemic control in patients with type 2 diabetes in Ethiopia. Methods: We performed searches in the online databases of PubMed, Google Scholar, Scopus, Science Direct, and the Cochrane Library. Microsoft Excel was used to extract data, and STATA statistical software (v. 16) was used for analysis. Publication bias was explored by forest plots, Begg's rank test, and Egger's regression test. To check for heterogeneity, I2 was computed. Subgroup analysis was conducted based on region and publication year. In addition, the pooled odds ratio for associated factors was calculated. Results: Out of 1,045 studies assessed, 23 studies were included fulfilling our inclusion criteria. In all, 6,643 individuals were enrolled in the study. It was estimated that 61.11% of type 2 diabetes patients had poor glycemic control (95% CI, 57.14-65.19). The subgroup analysis by study region and publication year revealed that the highest prevalence was observed in the Addis Ababa region (68.57%) and studies published before 2019 (61.76%), respectively. Poor glycemic control was associated with older age > 50 years (AOR = 2.12; 95% CI: 1.27-2.97), not attending formal education (AOR = 3.60; 95% CI: 2.75, 4.46), having diabetes for longer duration (10 years; AOR = 2.57; 95% CI: 1.65-3.49), having comorbidity (AOR = 2.43; 95% CI: 2.05-2.80), and low adherence to diabetes management (AOR = 3.67; 95% CI: 2.41-4.92). Conclusion: Our findings indicate a high prevalence of poor glycemic control among people with type 2 diabetes in Ethiopia. Being older, not attending formal education, having a longer duration of diabetes, having comorbidity, and having low adherence to diabetes management were all associated. Therefore, we recommend health organizations implement measures to monitor and control patients' blood glucose levels. Patient education and training of healthcare professionals could serve as a short-term strategy to achieve adequate glycemic control. Systematic review registration: PROSPERO, identifier CRD42022349792, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022349792.

Hotspot areas of tetanus-unprotected births and its associated factors in Ethiopia: Spatial analysis of EDHS data.

Neonatal tetanus persists as a public health problem in many developing countries including Ethiopia. Maternal tetanus toxoid vaccination is a cornerstone to prevent neonatal tetanus. However, its prevalence is low in Ethiopia, and little has been devoted to its spatial epidemiology and associated factors. Hence, this study aimed to explore the spatial pattern and factors affecting tetanus-unprotected births in Ethiopia. A further analysis of the 2016 Ethiopia Demographic and Health Survey data was conducted, and a weighted sample of 7590 women was used for analysis. Spatial analysis was done using ArcGIS and SaTScan software. A binary logistic regression model was fitted to identify factors and variables with a p-value <.05 were considered as statistically significant. About 54.13% (95% CI: 53.01, 55.25) of births were not protected against neonatal tetanus, and spatial clustering of tetanus unprotected births was observed (Moran's I = 0.144, p-value = .028). The primary and secondary SaTScan clusters were detected in Northeastern Tigray, Eastern Amhara, and almost the entire Afar (RR = 1.34 & LLR = 66.5, p < .01), and in the Somali region, and the western border of Gambela (RR = 1.44 & LLR = 31.3, p < .01), respectively. Tetanus unprotected births were higher among women without formal education (AOR = 1.63; 95% CI: 1.29, 2.04), came from poor households (AOR = 1.27; 95% CI: 1.12, 1.45), who had no ANC contact (AOR = 6.97; 95% CI: 6.21, 7.88), and who were not exposed to the media (AOR = 1.26; 95% CI: 1.09, 1.47). Hence, tetanus-unprotected birth hotspots require priority interventions, and it is good if the targeted interventions consider the identified factors.

Prevalence and factors associated with early resumption of sexual intercourse among postpartum women: Systematic review and meta-analysis.

INTRODUCTION: Postpartum sexual health is indicated by a resumption of sexual activity as well as arousal, desire, orgasm, and sexual satisfaction. The issue of resuming sexual intercourse after childbirth has received limited attention because healthcare professionals rarely provide adequate care to postnatal women. The present study aimed to ascertain the overall prevalence of early resumption of sexual intercourse among most women. METHODS: Searches were conducted in PubMed, Web of Science, Science Direct, Google Scholar, African Journals Online, and the Cochrane Library. Data were extracted using Microsoft Excel, and STATA version 14 was used for analysis. Publication bias was checked by funnel plot, Egger, and Begg regression tests. A p-value of 0.05 was regarded to indicate potential publication bias. Using I2 statistics, the heterogeneity of the studies was evaluated. By country, a subgroup analysis was conducted. A sensitivity analysis was carried out to determine the effect of each study's findings on the overall estimate. The random effects model was used to assess the overall effect of the study and then measured using prevalence rates and odds ratio with 95% CI. RESULTS: Twenty-one studies with 4,482 postpartum women participants were included in the study. The pooled prevalence of early resumption sexual intercourse among post-partum women was 57.26% (95% CI 50.14, 64.39) with significant heterogeneity between studies (I2 = 99.2%; P-value ≤ 0.000) observed. Current contraceptive use (AOR = 1.48, 95%CI = 1.03, 6.21), primipara (AOR = 2.88, 95%CI = 1.41, 5.89), and no history of severe genital injury on the last delivery (AOR = 2.27, 95%CI = 1.05, 4.93) were significantly associated with early resumption of sexual intercourse. CONCLUSION: This study found that more than half of women resumed sexual intercourse early after giving birth. This suggests that a significant number of women may be at higher risk of unwanted pregnancies, short birth intervals, and postpartum sepsis. Thus, stakeholders should improve the integration of postpartum sexual education with maternal health services to reduce the resumption of postpartum sexual intercourse.

Prevalence and Associated Factors of Cultural Malpractice During the Perinatal Period in Ethiopia: A Systematic Review and Meta-Analysis.

The health of the mother and children are potentially affected by several types of cultural malpractices that occur during the perinatal period. Ethiopia is a multi-ethnic nation where a variety of cultural practices are observed, especially during pregnancy, delivery, and the postpartum period. This study aimed to assess the prevalence and associated factors of cultural malpractice during the perinatal period in Ethiopia. Data searches were conducted in PubMed/Medline, Web of Science, Scopus, Google Scholar, African Journals Online, and the Cochrane Library. Data were extracted using Microsoft Excel, and analysis was done using STATA version 14. Less than a p-value of 0.05 was regarded to indicate potential publication bias: the funnel plot, Begg, and Egger's regression tests were used to examine publication bias. This study included 18 studies and 7880 mothers. The pooled prevalence of cultural malpractice during pregnancy, childbirth, and postpartum was 34.95% (95% CI: 27, 42.56), 31.18% (95% CI: 19.61, 42.76), and 45.83% (95% CI: 34.22, 57.45) respectively in Ethiopia. In addition, the following factors are statistically associated with the perinatal period: pregnancy: ANC follow-up (AOR = 3.06, 95%CI = 2.04, 4.58), educational status (AOR = 3.30, 95%CI = 1.99, 5.48), and residence (AOR 2.47, 95%CI, 1.601, 3.81); childbirth: ANC follow-up (AOR = 9.94, 95%CI = 2.05, 48.09), maternal age (AOR = 2.27, 95%CI = 1.56, 3.29), and maternal education (AOR = 10.37, 95%CI = 6.145, 17.51); during postpartum: ANC follow-up (AOR = 3.67, 95%CI = 1.96, 6.844), maternal education (AOR = 6.87, 95%CI = 3.26, 14.49), and residence AOR4.79, 95%CI, 2.97, 7.49). The pooled prevalence of cultural malpractice during the perinatal period was high. Health professionals should encourage beneficial practices through health education for a healthy perinatal period for mothers.

Scalability and Sustainability of a Surgical Infection Prevention Program in Low-Income Environments.

Importance: Surgical infections are a major cause of perioperative morbidity and mortality, particularly in low-resource settings. Clean Cut, a 6-month quality improvement program developed by the global nonprofit organization Lifebox, has demonstrated improvements in postoperative infectious complications. However, the pilot program required intense external programmatic and resource support. Objective: To examine the improvement in adherence to infection prevention and control standards and rates of postoperative infections in hospitals in the Clean Cut program after implementation strategies were updated and program execution was refined. Design, Setting, and Participants: This cohort study evaluated and refined the Clean Cut implementation strategy to enhance scalability based on a qualitative study of its pilot phase, including formalizing programmatic and educational materials, building an automated data entry and analysis platform, and reorganizing hospital-based team composition. Clean Cut was introduced from January 1, 2019, to February 28, 2022, in 7 Ethiopian hospitals that had not previously participated in the program. Prospective data initiated on arrival in the operating room were collected, and patients were followed up through hospital discharge and with 30-day follow-up telephone calls. Exposure: Implementation of the refined Clean Cut program. Main Outcomes and Measures: The primary outcome was surgical site infection (SSI); secondary outcomes were adherence to 6 infection prevention standards, mortality, hospital length of stay, and other infectious complications. Results: A total of 3364 patients (mean [SD] age, 26.5 [38.0] years; 2196 [65.3%] female) from 7 Ethiopian hospitals were studied (1575 at baseline and 1789 after intervention). After controlling for confounders, the relative risk of SSIs was reduced by 34.0% after program implementation (relative risk, 0.66; 95% CI, 0.54-0.81; P < .001). Appropriate Surgical Safety Checklist use increased from 16.3% to 43.0% (P < .001), surgeon hand and patient skin antisepsis improved from 46.0% to 66.0% (P < .001), and timely antibiotic administration improved from 17.8% to 39.0% (P < .001). Surgical instrument (38.7% vs 10.2%), linen sterility (35.5% vs 12.8%), and gauze counting (89.2% vs 82.5%; P < .001 for all comparisons) also improved significantly. Conclusions and Relevance: A modified implementation strategy for the Clean Cut program focusing on reduced external resource and programmatic input from Lifebox, structured education and training materials, and wider hospital engagement resulted in outcomes that matched our pilot study, with improved adherence to recognized infection prevention standards resulting in a reduction in SSIs. The demonstration of scalability reinforces the value of this SSI prevention program.

Intention to Use Postpartum Contraceptive and Its Determinants in Sub-Saharan Africa: Systematic Review and Meta-Analysis.

Background: The postpartum period is a critical moment for the delivery of family planning services. However, the utilization of family planning among women in sub-Saharan Africa is not optimal. Therefore, the current study aims to assess the intention to use postpartum contraception and its related determinants in the sub-Saharan African setting. Methods: This study utilized a comprehensive search strategy that involved searching several databases, including PubMed, Scopus, EMBASE, Science Direct, Google Scholar, and online research institutional repository homes. Data extraction was performed using Microsoft Excel, and statistical analysis was conducted using STATA software (version 14). To assess publication bias, a forest plot, Begg's rank test, and Egger's regression test were employed. Heterogeneity was evaluated using the I2 statistic, and an overall estimated analysis was conducted. In addition, sensitivity analysis was performed to examine the impact of each study on the overall estimate. Meta-regression analysis was conducted to identify potential sources of heterogeneity. Finally, the pooled odds ratio (OR) for associated factors was calculated. Result: After reviewing 1,321 articles, 14 studies were deemed eligible for inclusion in this meta-analysis. The final analysis comprised a total of 39,936 study participants. The overall intention to use postpartum contraception in sub-Saharan Africa was found to be 62.21% (95% confidence interval [CI]: 55.532-68.875). In subgroup analysis, the highest prevalence of intention was observed in Ethiopia (66.71%; 95% CI: 50.36-83.05), while the lowest prevalence was reported in Ghana (59.39%; 95% CI: 50.22-68.57). The intention to use contraception was found to be 67.22% (95% CI: 62.37-72.07) and 54.53% (95% CI: 46.61-62.45) for institutional and community-based studies, respectively. Maternal educational status (OR = 1.22; 95% CI: 1.09-1.38) and husbands' approval of contraceptive use (OR = 2.395; 95% CI: 1.256-4.567) were identified as predictors of intention to use postpartum contraception. Conclusion: In conclusion, the results of our study show a comparatively low intention toward the use of postpartum contraception, in contrast to findings reported in other countries. As such, we recommend that stakeholders prioritize maternal education and encourage male partner involvement in family planning decisions.

Utilization of non-pneumatic anti-shock garment for treating obstetric hemorrhage and associated factors among obstetric care providers in Ethiopia: A systematic review and meta-analysis.

BACKGROUND: The non-pneumatic anti-shock garment (NASG) is a life-saving device that can help to avoid delays and prevent further complications in the case of obstetric hemorrhage. Although there are many fragmented primary studies on the NASG utilization in Ethiopia, the pooled utilization rate is unknown. In addition, a disagreement was observed among those studies while reporting the associated factors. Therefore, this study was intended to determine the pooled level of NASG utilization and its associated factors among obstetric care providers in Ethiopia. METHODS: A total of 51 studies were retrieved from PubMed, Google Scholar, the African Journal of Online, direct open-access journals, and Ethiopian universities' institutional repositories. This study was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The quality of studies was evaluated using the modified Newcastle-Ottawa quality assessment tool. The data were extracted by two authors independently using Microsoft Excel and analyzed by Stata version 11. A random-effects model was applied to calculate the pooled level of NASG utilization and its associated factors. The PROSPERO registration number for the review is CRD42023414043. RESULT: A total of 8 studies comprising 2,575 study participants were involved in this meta-analysis. The pooled utilization rate of NASG was found to be 39.56%. Having NASG training (pooled odds ratio (OR) = 3.99, 95%CI = 2.35, 6.77), good knowledge about NASG (OR = 2.92, 95%CI = 2.04, 4.17), a positive attitude towards NASG (OR = 3.17, 95%CI = 2.10, 4.79), and having ≥ 2 NASGs in the health facility (OR = 10.59, 95%CI = 6.59, 17.01) were significantly associated with NASG utilization. CONCLUSION: Utilization of NASG for the treatment of obstetric hemorrhage was low in Ethiopia. To increase its utilization, Ministry of Health should improve the accessibility of NASG at each health facility and increase the Health professionals' knowledge and attitude through in-service and pre-service training.

Unintended pregnancy and contraceptive use among women in low- and middle-income countries: systematic review and meta-analysis.

INTRODUCTION: Unintended pregnancy is a leading cause of maternal mortality associated with abortion, inadequate contraceptive use, contraceptive failure, and contraceptive discontinuation in low- and middle-income countries. Most unintended pregnancies occur in regions with limited availability of maternal health services, resulting in a significant number of maternal deaths. Therefore, this review aimed to assess the overall prevalence of unintended pregnancy among women using contraceptives in low- and middle-income countries. METHOD: PubMed, Science Direct, Google Scholar, Scopus, and the Ethiopian University Online Library were searched. Data were extracted using Microsoft Excel and analyzed using STATA statistical software (version 14). Publication bias was checked using forest plot, Begg rank test, and Egger regression test. To check for heterogeneity, I2 was calculated and an overall estimation analysis was performed. Subgroup analysis was conducted by study setting, study design, and publication. The Joanna Briggs Institute quality assessment tool was used to assess the quality of each study. We performed a one-time sensitivity analysis. RESULTS: Of the 1304 articles retrieved, 23 studies (involving 40,338 subjects) met the eligibility criteria and were included in this study. The pooled prevalence of unintended pregnancy among women using contraceptives in low- and middle-income countries was 44.68% (95% CI: 35.16-54.20; I2 = 99.7%, P < 0.001). Based on subgroup analysis, the pooled prevalence of unintended events was 43.58% (CI: 32.99, 54.173) and 49.93% (CI: 28.298, 71.555) for cross-sectional and cohort studies, respectively. Based on the study design, it was 34.47% (CI: 27.012, 41.933) for community studies and 55.85% (CI: 33.364, 78.339) for institutional studies. CONCLUSION: The overall prevalence of unintended pregnancy was high among women using contraceptives in low- and middle-income countries. Therefore, it is better to pay attention to prevention strategies for unintended pregnancy, such as information and education accessibility and contraceptive utilization.

Anthropometric Measurements of Singleton Live Full-Term Newborns in Comparison to Who Standard at University of Gondar Comprehensive Specialised Hospital, Ethiopia.

BACKGROUND: Anthropometry is a universally applicable, non-expensive, rapid and noninvasive technique used to evaluate and reflect the nutritional status of an individual. Anthropometric measurements of newborns reflect their general health, nutritional status and future survival by tracking trends in growth and development over time. It has also considerable significance in terms of determining the risk of death and extra uterine complications. Most previously conducted studies assessing newborn anthropometry had used birth weight as the sole parameter. But it is apparent that other anthropometric measurements, such as length and head circumference, are also important in predicting short-term and long-term outcomes. So this study assesses anthropometric measurements of singleton live full-term newborns at University of Gondar comprehensive specialised hospital, Ethiopia. MATERIAL AND METHODS: Hospital-based cross-sectional study was conducted among 333 newborn from 5 June to 11 July 2022, in the maternity and neonatal ward of University of Gondar comprehensive specialised hospital. A systematic random sampling technique was employed to select the study participants. The Kobo toolbox software platform was used for data collection, and STATA software version 16 was used for analysis. RESULTS: The mean birth weight, length and head circumference of the newborns in the current study were 2977 grams (95% CI: 2935.7, 3018.3), 47.05 centimeters (95% CI: 46.72-47.37) and 34.7 centimeters (95% CI: 34.6, 34.88), respectively. The prevalence of SGA (< 10th percentile) and LGA (> 90th percentile) was 20.12% and 6.01%, respectively. Independent samples t-test was done to see the association of newborn sex with anthropometric indices, and the result showed that the difference was statistically insignificant in all of anthropometric parameters. CONCLUSION: This study of normal reference values will provide basic step for future standardisation of Ethiopian term newborns anthropometric parameters to be used for accurate assessment of newborns.

Early marriage and its associated factors among women in Ethiopia: Systematic reviews and meta-analysis.

BACKGROUND: Early marriage is defined as the union of one or both partners before reaching the age of 18 for the first time. This practice is widely prevalent in underdeveloped countries, particularly in Ethiopia, and has been observed to have detrimental effects on the educational and personal development of both male and female individuals. METHODS: The present study conducted a comprehensive search of the Science Direct, Scopus, Google Scholar, EMBASE, and PubMed databases. The data were extracted using Microsoft Excel (version 14) and analyzed using STATA statistical software. To examine publication bias, a forest plot, rank test, and Egger's regression test were utilized. Heterogeneity was assessed by calculating I2 and conducting an overall estimated analysis. Additionally, subgroup analysis was performed based on the study region and sample size. The pooled odds ratio was calculated. RESULTS: Out of a total of 654 articles, 14 papers with 67,040 research participants were included in this analysis. The pooled prevalence of early marriage among women in Ethiopia was 56.34% (95% CI: 51.34-61.34), I2 = 78.3%). The Amhara region exhibited the highest prevalence of early marriage, with a rate of 59.01%, whereas the Oromia region demonstrated the lowest incidence, with a prevalence rate of 53.88%. The prevalence of early marriage was found to be 58.1% for a sample size exceeding 1000, and 50.9% for a sample size below 1000. No formal education (AOR = 5.49; 95%CI: 2.99, 10.07), primary education (AOR = 3.65; 95%CI: 2.11, 6.32), secondary education (AOR = 2.49; 95%CI: 1.60, 3.87), rural residency (AOR = 4.52; 95%CI: 1.90, 10.74) and decision made by parents (AOR = 2.44; 95%CI: 1.36, 4.39) were associated factors. CONCLUSION AND RECOMMENDATION: In Ethiopia, there was a high rate of early marriage among women. The research findings indicate that early marriage is more prevalent among mothers who possess lower levels of educational attainment, reside in rural areas, and are subject to parental decision-making. Our stance is firmly in favor of expanding the availability of maternal education and promoting urban residency. Furthermore, the promotion of autonomous decision-making by clients regarding their marital affairs is of paramount importance to family leaders.